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The Fight to End Pandemics

Editor’s Note: Larry Brilliant is CEO of Skoll Global Threats Fund which works on climate, nuclear, pandemic, water and Middle East conflicts. Brilliant helped lead the successful WHO smallpox eradication programme in India.

World Health Day – April 7 – honors the creation of the World Health Organization (WHO) in 1948. Each year, we celebrate the advances in global health and the role that the WHO plays both in improving health and elevating health on the global agenda.

Today, even as many had thought we could finally turn our attention to the increasing importance of chronic diseases like diabetes, cancer and heart disease, infectious diseases like malaria and tuberculosis, as well as the continuing pandemic of HIV/AIDS, remain stubbornly high on the global agenda.

We are reminded daily of the role that the WHO plays in fighting these top three infectious disease killers. At the same time, an alphabet soup of influenzas, including the new H7N9 outbreak in China, smoldering incidents of H5N1 bird flu in Southeast Asia, and even periodic reminders of the 2009 H1NI swine flu pandemic, remain front of mind. On top of that, global health workers must confront other zoonotic diseases, including new SARS-like coronaviruses detected from countries as diverse as Saudi Arabia and the UK, as well as old nemeses like Hantavirus, which recently showed up unexpectedly in California’s Yosemite National Park, and countless other epidemics.

For historical importance on today’s WHO birthday list, however, nothing tops the heroic struggle to eradicate polio. This ancient scourge has been beaten back, village by village, country by country, so that, remarkably, it is now endemic in only three countries: Pakistan, Afghanistan and Nigeria. India, one of the ancient homes for polio, has mustered millions of volunteers to join a national polio eradication campaign supported by the WHO, UNICEF, Rotary, the Bill and Melinda Gates Foundation and others. It has had remarkable recent success: there has not been a single case of polio in India in two years. While eradicating polio is a huge, complex, global team effort, we cannot overstate the importance of the WHO’s leadership role in the polio eradication campaign.

As someone who is almost the same age as the WHO, and whose first job out of medical school was working for the WHO smallpox program, I reflect with collective pride on the success of the WHO program that eradicated smallpox three decades ago, the organization’s crowing achievement to date. But eradicating polio would mean “two” instead of “one” disease eliminated from the list of humanity’s woes–proving that eradication is not a unique event. So this second disease eradicated might be even be sweeter. It has taken a very long time, cost a great amount of treasure, and no small number of public health workers lives. But we are getting very close on polio, and I am optimistic.

In fact, I’m optimistic broadly about our ability to effectively tackle nearly all of our communicable diseases foes, old and new. Why?

The arc of my career – from physician to public health practitioner, from government to business to philanthropy – has given me a unique view into public health trends over the last four decades. One key change in global public health over this time has been the rise of non-state actors. Decades ago, global public health was almost synonymous with the annual World Health Assembly in Geneva, largely the domain of health ministers setting goals and policies for WHO staff to implement. It would have been unthinkable for the NGO sector, let alone individuals, foundations, companies or even universities to play much of a role. Today, it’s vastly different, with public advocacy groups, civil society players that span the globe, and foundations like Bill and Melinda Gates,Rockefeller and others joining UN agencies and bilateral donors in the global health conversation. Over the last ten years, much innovation has come from these newer players. Social entrepreneurs, advocacy groups, and nimble non-profits are creating new systems, new technologies and developing new models for delivering health care, particularly to underserved populations.

Thanks to recent changes in the International Health Regulations, we’ve seen another type of non-state actor emerge: digital data players. Since 2007, countries have been obligated to increase their reporting on a wide range of newly emergent diseases with the potential to spread beyond borders. For cash starved health ministries, this additional obligation might have been an economic burden. But the new rules also provided new tools: countries can now tap into informal sources of disease information as part of their official reporting. This has spurred the creation of new tools and new organizations, ramping up disease surveillance capacity significantly.

and HealthMap, which combines elements of several of these systems to display real time maps of diseases around the world.

These are a few of dozens of examples of the new tools that can help piece together what’s happening worldwide on contagious diseases. They and others like them have helped reduce the lag between a disease outbreak and its detection. A study published several years ago in the Proceedings of the National Academy of Sciences reported that the lag time from the first occurrence of a new pandemic potential disease was over 5 months—167 days —in 1996; but by 2009 it had dropped to 23 days, just over 3 weeks. When we find outbreaks faster, we can limit their spread.

At the Skoll Global Threats Fund, we’ve recently helped launch (in partnership with the APHA and HealthMap) a tool that goes one step further – getting people to actively participate in public health by self reporting each week on symptoms. Flu Near You now has nearly 80,000 users in the US. Each week, participants receive an email (or mobile app notification) where they click on a link to report whether they’ve experienced any of eight symptoms related to flu, or, alternatively, were symptom free. This then populates a map showing flu prevalence geographically in real time, as well as pointing users to nearby flu resources, for example, pharmacies with vaccines. This follows other similar systems, FluTracking in Australia andInfluenzanet in Europe. We’re exploring together whether this type of participatory surveillance can help us find and react to outbreaks even more quickly. Of course, it is not just about flu; the hope is to learn how to work worldwide with a host of diseases in the next few years.

As far as infectious diseases, global public health has never been stronger than it is today. But our challenges remain substantial. The speed of travel and just-in-time global supply chains means a pandemic can spread faster than ever before, with greater economic and health impacts than even before. But advances in surveillance tools like the ones I’ve mentioned, improvement in point of care diagnostics, and the emergence of regional surveillance structures in key regions, all give us a more than fighting chance against new and old communicable disease.

At the Prince Mahidol Awards Conference in Bangkok this January, a new organization was launched called CORDS (Connecting Organizations for Regional Disease Surveillance). Made up of six regional disease surveillance networks in the Middle East, Southern and East Africa, South East Asia and Eastern Europe (each of which are in turn partnerships of several national health ministries), CORDS has the potential to speed best practices and help innovate rapid disease detection and response. The group that funded and partnered to create CORDS includes the Rockefeller Foundation, NTI,Fondation Merieux, Peter G. Peterson Foundation, the Bill and Melinda Gates Foundation, and our own Skoll Global Threats Fund. And getting back to World Health Day, key multilateral organizations working together with CORDS include the Food and Agriculture Organization, the World Organization for Animal Health, and the most important global health agency of all, the WHO.

That WHO, global foundations, NGOs, government health ministries and regional networks around the world are all working together is a great take-away for today’s World Health Day. While there may be a never-ending supply of new viruses jumping from animals to humans, we now have innovations in technology and governance more than equal to the challenge. In fact, we may be at a stage where we can realistically talk about not only eradicating our “second” disease, polio, but even ending pandemics.

And that is something worth celebrating. So join me today on World Health Day, put 65 candles on that birthday cake, make a wish that polio joins smallpox in the dustbin of history and that we work together to prevent any new infectious disease nightmares, and let’s celebrate WHO and the role it has played–and will continue to play–year after year, birthday after birthday.

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